Eczema: the facts
Eczema is a long-term skin condition. It does affect people of all ages, but happens most often in childhood. Its full name is ‘atopic eczema’. The ‘atopic’ bit refers to a group of conditions (also including asthma and hayfever) that can be inherited, and involve particular immune reactions.
Eczema tends to have intermittent flares of redness, bumpiness and itching. In between flares, eczema may be barely visible, apart from causing a background dryness of the skin. Some (but not all) flares are caused by triggers in the environment.
If your child has eczema, the good news is that it will tend to get better over time. This isn’t always the case, but around three-quarters of children with eczema will be clear of the condition by the time they’re 16.
What triggers eczema?
There are some common situations where eczema can worsen:
- over-washing (this particularly applies to hand eczema)
- exposure to dry (eg centrally-heated) air
- excessive scratching, rubbing and chafing of the skin
Actively inflamed eczema is itchy, which may make your child scratch. How much someone scratches varies depending on the individual. It can also be exacerbated by other factors like anxiety and stress. Scratching might give short-term relief, but it soon becomes counterproductive as it makes the eczema worse. The scratching may also becomes automatic, happening more when your child is undressed when the skin is accessible, or at night time. The scratching then inflames the skin further, making it even more itchy, which encourages more scratching. This is known as the ‘itch- scratch cycle’.
Scratching can create small splits in the skin, meaning a common bacteria called staphylococcus can enter the skin. This can make the eczema much worse. The signs of bacterial skin infection may be oozing, yellow crusts or even spots of pus. If you notice the signs of skin infection, go to the doctor for antibiotics to try to limit the eczema flare-up that usually results from this.
You may hear people suggest that certain foods can be a trigger for eczema. It’s true that diet can play a part but only in very few people, and generally only those with moderate to severe eczema who are under three years of age.
How can I manage my child’s eczema?
First thing’s first when it comes to managing your child’s eczema: try and avoid an episode being triggered. This means:
- Don’t overwash your child. Avoid using soap on very young children, and when they’re a little older use moisturising soap substitutes.
- Try not to let the air in the room get too dry: ventilate the room by having a window slightly open.
- Don’t overdress your child, especially at night time – overheating and sweating can be a trigger.
If you can, try to limit ‘over-scratching’ that will aggravate eczema. Be aware of your child’s scratching habits, and use distraction at times when stress may be promoting more scratching. It might also help to limit your child’s access to their skin, especially at night. For very young children, cotton mittens can limit the damaging effects of scratching. Pyjama suits or light cotton netting suits are useful for slightly older children.
Try to motivate older children to apply emollient themselves at times when they’re prone to scratching. This should encourage them into good habits.
These basic steps will help to protect against some of the most common triggers. It will also help if you have a good understanding of exactly what makes your child’s eczema flare up. You might want to monitor flare ups by keeping a diary, to help you manage your child’s own specific triggers.
However, you can only reduce the risk up to a certain point; you can’t completely rule it out. If your child does have an active episode, it’s important to know how to manage it.
As eczema skin is naturally more dry, it is said to have a reduced skin barrier. So the main thing that will help you out is an emollient. This is an oily or waxy cream that acts as a barrier or seal, protecting your child’s skin against irritation.
Here are some tips for selecting and using an emollient:
- The richer (meaning waxier or oilier it is), the better. Don’t go for light, watery creams that are easily absorbed, as they provide very little long-lasting skin barrier protection.
- Ensure your child uses the emollient often (at least twice a day) and applies plenty of it each time. People tend to under-use them. To help with this, it may be helpful for your child to have one tub or bottle for home, and one kept at school.
- It’s particularly important to use it just after your child has washed.
- Smooth the emollient gently into the skin in one direction, rather than rubbing it in. (Rubbing can set off a scratching episode.)
- You can reduce the risk of infection by using a pump dispenser. If you do use one in a pot, use a clean spoon or spatula to get it out of the pot – not your fingers.
- Don’t let your child share their emollient with anyone else; this will also reduce infection risk
Whatever emollient product you choose or are prescribed, remember to read the label carefully before you start using it.
Recent research shows that emollients have a protective effect as well. So don’t stop using the emollient once the flare-up appears to have calmed down. Continue to apply it regularly to maintain the barrier protecting your child’s skin.
Corticosteroids and other treatments
If your child has mild eczema, the doctor may also prescribe a low-strength version of a medicine called a corticosteroid. They will explain more about this when they prescribe it.
If your child’s eczema is moderate or severe, they should be under the care of a doctor. There are lots of other treatments a doctor can try in these more serious circumstances. They’ll explain about these, but you can also find out more in our topic page on eczema.
Here at Bupa we understand how important your family is. So with our family health insurance you can rest assured knowing that eligible treatment and support is available for your loved ones when they need it.